Chiropractic Treatment of Spinal Fracture

Two recent studies have been published that discuss the successful management of spinal fractures with chiropractic treatment.

The first1 describes the case of a 49-year-old man who, after a fall on his buttocks, developed an "oblique (zone III) fracture through the fifth sacral segment with slight anterior displacement of the distal fragment."

"Neurological examination was unremarkable. On orthopaedic examination, the buttock pain was elicited by stressing the sacroiliac (SI) joints, but the distal sacral pain was not aggravated. Patrick's test was negative."

"Palpation revealed marked tenderness of the distal sacrum. Both SI joints were tender and hypermobile. Palpation of the lumbosacral and gluteal musculature did not recreate the patient's symptoms."

"After obtaining the patient's informed consent, the SI joints were manipulated with the patient in side-posture, once on each side, with a contact over the proximal SI joint. Interferential current was applied over the sacrum for analgesia. The patient felt markedly improved immediately."

Further chiropractic treatment consisted of four daily treatments, and then five more treatments during the next two weeks. At that time the patient was discharged.

In the second case2, the authors describe the case of a 18-year-old man with a Chance fracture of L3. The man was sitting in the middle rear seat of a car that hit a tree. He was taken by ambulance to the emergency room, where the resident physician told him that radiographic findings were normal. He reported low back pain and paresthesia in the left leg. He was given pain medications and sent home.

The patient had the same symptoms 3 days later, but was again told that everything was normal. An orthopaedic surgeon then evaluated the radiographs and diagnosed a "nondisplaced fracture of L3 confined to the posterior fourth of the vertebral body."

The patient was brought to the chiropractic physician twelve days after the accident. "The chiropractic interpretation of the radiographic examination contradicted the opinion verbally provided by the orthopedist at the hospital. Plain films demonstrated a Chance fracture of L3, extending from both laminae through the pedicles and transverse processes and continuing into the posterior-inferior portion of the vertebral body of L3, passing through the inferior end-plate. It was clear that there was a posterior displacement of the posterior-inferior aspect of the upper part of the L3 vertebral body."

After careful examination of radiographs and CT images, chiropractic treatment was instituted.

"After the second adjustment to L3, the paresthesia to the left leg had resolved and the low back pain had reduced considerably. The patient was adjusted on three occasions at L3 over the course of a week...Approximately 1 month after beginning chiropractic care, the patient reported that the leg symptomatology, including the uncontrollable knee flexion, was very much improved."

At four months after the accident, the patient had no paresthesia in the left leg, and had occasional minor low back pain.

The authors of both studies warn that extreme caution should be observed when working with severe spinal trauma. We recommend that those interested in these studies obtain complete copies for themselves.

Steiman I, Grod JP. Spinal manipulation in a case of sacral fracture: presentation in a chiropractic office. Journal of the Canadian Chiropractic Association 1996;40(3):145-149.

Plaugher G, Alcantara J, Hart CR. Management of the patient with a Chance fracture of the lumbar spine and concomitant subluxation. Journal of Manipulative and Physiological Therapeutics 1996;19(8):539-551.